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Acquisition of Multidrug-Resistant Organisms Among Hospital Patients Hospitalized in Beds Adjacent to Critically Ill Patients

Published online by Cambridge University Press:  08 April 2017

Matan J. Cohen ,
Olga Anshelevich ,
David Raveh ,
Ellen Broide ,
Bernard Rudensky  and
Amos M. Yinnon
Matan J. Cohen*
Affiliation:
Infectious Diseases Unit, Hebrew University–Hadassah Medical School, Jerusalem, Israel Shaare Zedek Medical Center, (affiliated with the faculty of Health Sciences, Ben–Gurion University of the Negev, Beer-Sheva, Israel), and the, Hebrew University–Hadassah Medical School, Jerusalem, Israel
Olga Anshelevich
Affiliation:
Infectious Diseases Unit, Hebrew University–Hadassah Medical School, Jerusalem, Israel Department of Geriatrics, Hebrew University–Hadassah Medical School, Jerusalem, Israel
David Raveh
Affiliation:
Infectious Diseases Unit, Hebrew University–Hadassah Medical School, Jerusalem, Israel
Ellen Broide
Affiliation:
Infectious Diseases Unit, Hebrew University–Hadassah Medical School, Jerusalem, Israel Clinical Microbiology Laboratory, Hebrew University–Hadassah Medical School, Jerusalem, Israel
Bernard Rudensky
Affiliation:
Clinical Microbiology Laboratory, Hebrew University–Hadassah Medical School, Jerusalem, Israel
Amos M. Yinnon
Affiliation:
Infectious Diseases Unit, Hebrew University–Hadassah Medical School, Jerusalem, Israel Shaare Zedek Medical Center, (affiliated with the faculty of Health Sciences, Ben–Gurion University of the Negev, Beer-Sheva, Israel), and the, Hebrew University–Hadassah Medical School, Jerusalem, Israel
*
Infectious Disease Unit, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel ([email protected])
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Abstract

Objective.

To assess whether patients hospitalized in beds physically adjacent to critically ill patients are at increased risk to acquire multidrug-resistant pathogens.

Design.

Cohort study.

Setting.

Shaare Zedek Medical Center, a 550-bed medical referral center.

Patients.

From April to September 2004, we enrolled consecutive newly admitted patients who were hospitalized in beds adjacent to either mechanically ventilated patients or patients designated as “do not resuscitate” (DNR). For each of these patients, we also enrolled a control patient who was not hospitalized in a bed adjacent to a critically ill patient. We collected specimens from the anterior nares, the oral cavity, and the perianal zone at the time of admission and subsequently at 3-day intervals until discharge or death. Specimens were cultured on selective media to detect growth of antibiotic-resistant pathogens, including Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β lactamase (ESBL)–producing Enterobacteriaceae, and vancomycin-resistant enterococci (VRE).

Results.

We enrolled 46 neighbor-control pairs. Among neighbors and controls, respectively, the incidence rates for isolation of A. baumannii was 8.3 and 4 isolations per 100 patient-days (relative risk [RR], 2.1 [95% confidence interval {CI}, 0.8-5.2]; P = .12), the incidence rates for MRSA were 1.4 and 2.6 isolations per 100 patient-days (RR, 0.6 [95% CI, 0.1-2.3]; P = .45), the incidence rates for ESBL-producing Enterobacteriaceae were 10.5 and 9 isolations per 100 patient-days (RR, 1.2 [95% CI, 0.6-2.4]; P = .84), the incidence rates for VRE were 4.3 and 4.8 isolations per 100 patient-days (RR, 0.9 [95% CI, 0.3-2.4]; P = 1), and the composite incidence rate was 21.7 and 16.2 isolations per 100 patient-days (RR, 1.3 [95% CI, 0.8-2.3]; P = 0.3).

Conclusions.

In this pilot study, we did not detect an increased incidence rate of isolation of multidrug-resistant pathogens among patients hospitalized in beds adjacent to critically ill patients. Further studies with larger samples should be conducted in order to generate valid data and provide patients, physicians, and policy makers with a sufficient knowledge base from which decisions can be made.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 7 , July 2006 , pp. 675 - 681
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1.Grundmann, H, Bärwolff, S, Tami, A, et al. How many infections are caused by patient-to-patient transmission in intensive care units? Crit Care Med 2005; 33:946–951.CrossRefGoogle ScholarPubMed
2.Nijssen, S, Bonten, MJM, Weinstein, RA. Are active microbiological surveillance and subsequent isolation needed to prevent the spread of methicillin-resistant Staphylococcus aureus? Clin Infect Dis 2005; 40:405–409.CrossRefGoogle ScholarPubMed
3.National Committee for Clinical Laboratory Standards (NCCLS). Performance Standards for Antimicrobial Disk Susceptibility Testing. Informational supplement M100-S9. Wayne, PA; NCCLS; 2004.Google Scholar
4.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995; 33:2233–2239.CrossRefGoogle ScholarPubMed
5.Bradley, SF. Staphylococcus aureus infections and antibiotic resistance in older adults. Clin Infect Dis 2002; 34:211–216.CrossRefGoogle ScholarPubMed
6.Paterson, DL. Extended-spectrum beta-lactamases: the European experience. Curr Opin Infect Dis 2001; 14:697–701.CrossRefGoogle ScholarPubMed
7.Murray, BE. Vancomycin-resistant enterococcal infections. N Engl J Med 2000; 342:710–718.CrossRefGoogle ScholarPubMed
8.Cisneros, JM, Rodríguez-Bano, J. Nosocomial bacteremia due to Acinetobacter baumannii: epidemiology, clinical features and treatment. Clin Microbiol Infect 2002; 8:687–693.CrossRefGoogle Scholar
9.Vincent, JL. Nosocomial infections in adult intensive-care units. Lancet 2003; 361:2068–2077.CrossRefGoogle ScholarPubMed
10.Goossens, H, Ferech, M, Stichele, RV, Elseviers, M, for the ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005; 365:579–587.CrossRefGoogle ScholarPubMed
11.Albrich, WC, Monnet, DL, Harbarth, S. Antibiotic selection pressure and resistance in Streptococcus pneumoniae and Streptococcus pyogenes. Emerg Infect Dis 2004; 10:14–17.CrossRefGoogle ScholarPubMed
12.Bergman, M, Huikko, S, Pihlajamaki, M, Palva, E, Huovinen, P, Seppala, H. Effect of macrolide consumption on erythromycin resistance in Streptococcus pyogenes in Finland in 1997–2001. Clin Infect Dis 2004; 38:1251–1256.CrossRefGoogle ScholarPubMed
13.Guillemot, D, Carbon, C, Balkau, B, et al. Low dosage and long treatment duration of beta-lactams: risk factors for carriage of penicillin-resistant Streptococcus pneumoniae. JAMA 1998; 279:365–370.CrossRefGoogle ScholarPubMed
14.Arason, VA, Kristinsson, KG, Sigurdsson, JA, Stefansdottir, G, Molstad, S, Gudmundsson, S. Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross-sectional prevalence study. BMJ 1996; 313:387–391.CrossRefGoogle ScholarPubMed
15.Harbarth, S, Harris, AD, Carmeli, Y, Samore, MH. Parallel analysis of individual and aggregated data on antibiotic exposure and resistance in gram-negative bacilli. Clin Infect Dis 2001; 33:1462–1468.CrossRefGoogle ScholarPubMed
16.Cepeda, JA, Whitehouse, T, Cooper, B, et al. Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 2005; 365:295–304.CrossRefGoogle ScholarPubMed
17.Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003; 290:1899–1905.CrossRefGoogle ScholarPubMed
18.Cooper, BS, Stone, SP, Kibbler, CC, et al. Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modeling. Health Technol Assess 2003; 7:1–194.CrossRefGoogle Scholar
19.Cooper, BS, Stone, SP, Kibbler, SP, et al. Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature. BMJ 2004; 329:533–540.CrossRefGoogle ScholarPubMed